The Neuropsychology of Learning Disabilities

Report
Advanced Cross-Battery Assessment
Using CHC Theory and
Neuropsychological Measures
Catherine A. Fiorello, Ph.D., ABPP
Temple University
September 30, 2011
Workshop Objectives
Participants will be able to:
• Use XBA to detect processing deficits in
identifying students with LD and ADHD
• Describe how processing assessment can be
integrated within an RtI model
• Understand how CHC Theory and
neuropsychological assessment work together
Cognitive Product or Process:
Synthesizing Paradigms
Nomothetic
Assessment
Idiographic
Assessment
• Compares individual to
norm
• Focuses on score:
Assessment Product
• Interpret levels of
performance
• Compares individual to
self
• Focuses on
performance:
Assessment Process
• Interpret patterns of
performance
BOTH essential for effective assessment and intervention
IDEA 2004: The Impetus for
Developing Better Assessment
and Intervention Strategies
Identifying Children with Learning Disabilities:
IDEA Definitions and Practices
Defining Learning Disabilities
• Learning Disabilities is a disorder of one or more of the basic
psychological processes that adversely affects educational achievement
in one or more academic domains
Determining Learning Disabilities
• Discrepancy between “ability” and “achievement” (typically
using cut-off points and global IQ)
• Failure to respond to scientific research-based intervention
• May permit the use of other alternative research-based
procedures for determining whether a child has a specific
learning disability, as defined in §300.8(c)(10) (OSERS
Final Regulations-8/06)
RtI as Prereferral Process
• Prereferral interventions, with good progress
monitoring, are essential to serving children.
• Interventions may help a large number of
children (e.g., Torgeson, early reading, 9496%).
• Tracking response to intervention provides
good information about what works and what
doesn't.
• Avoids “waiting to fail.”
Problems with RtI
• Established interventions for many referral
problems do not exist.
• Agreement on goal setting (what is failure to
respond?) can be problematic.
• Many children are referred for multiple areas
of difficulty.
• Failure to respond may be due to many
reasons other than disability.
RtI and LD
• RtI provides valuable information as part of an
evaluation for learning disabilities
• A failure to respond to interventions is not, by
itself, diagnostic of a learning disability.
• Cognitive and neuropsychological processing
is critical to identifying LD.
• School psychologists can and should evaluate
processing.
Fiorello Comprehensive RTI Model
High quality research-based teaching
~85%
Universal
screening
Protocol-based interventions
~10%
Individual
screening
Personalized interventions
Comprehensive
assessment:
cog/neuro/ach
ecobehavioral
personality etc.
IEP
~3
%
~2%
Implications for Assessment and Intervention
Cognitive Hypothesis Testing Model
Theory
1. Presenting Problem
5. Cognitive Strengths/Weaknesses
9. Intervention Consultation
Interpretation
Hypothesis
13. Continue/Terminate/Modify
4. Interpret IQ or Demands Analysis
2.Intellectual/Cognitive Problem
8. Interpret Constructs/Compare
6. Choose Related Construct Test
12. Determine Intervention Efficacy
Data Collection
10. Choose Plausible Intervention
3. Administer/Score Intelligence Test
7. Administer/Score Related Construct Test
11. Collect Objective Intervention Data
Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s Handbook.
New York, NY: Guilford Press.
Processing and LD
• Literature in cognition, cognitive assessment,
neuropsychology, and learning disabilities
links cognitive processing with achievement
and LD.
• Regular education curricula tend to focus on a
few areas of processing (e.g., phonemic
awareness) to the exclusion of many others.
• Once there has been failure to respond,
process assessment can be used to develop
interventions.
School Neuropsychology: The Key to
Reconceptualizng Cognitive Processes
for Assessment and Intervention
The Two Axes Interpretation
Anterior
-Executive Functions
-Motor Output
Posterior
-Sensory Input
-Comprehension
Structural Hemispheric Differences
Left Hemisphere
Right Hemisphere
More
Grey
Matter
More
White
Matter
More
Primary
Cortex
More
Association
Cortex
More
Intramodal
Connections
More
Intermodal
Connections
Source: Goldberg, E., & Costa, L. D. (1981). Hemispheric differences in the acquisition and use of
descriptive systems. Brain and Language, 14, 144-173.
The Two Axes Interpretation
Anterior
-Executive Functions
-Motor Output
Left Hemisphere
Right Hemisphere
-Routinized/Detailed/Local
-Convergent/Concordant
-Crystallized Abilities
-Novel/Global/Coarse
-Divergent/Discordant
-Fluid Abilities
Posterior
-Sensory Input
-Comprehension
Is There Evidence?
•
•
•
•
•
Newborn language processing
Musician processing of symphonies
American Sign Language in the deaf
Brain activation in novice-new learning vs. expert-learned
Bilateral fMRI activation: Left and right for Verbal; Right
and left for nonverbal processing
Psychological processes matter more than
stimulus input or response output!
Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s
Handbook. New York, NY: Guilford.
Hemispheric Functions and
Language
Left Hemisphere
Right Hemisphere Source
Routinized/Automatic Novel/New Learning Goldberg/Costa, 1981
Low Demand
High Demand
Belger & Banich, 1998
Local/Detailed
Global/Holistic
Delis et al., 1986
Microstructural
Macrostructural
Glosser, 1993
Fine Processes
Coarse Processes
Beeman/Chiarello, 1998
Close Semantic
Distant Semantic
Chiarello, 1998
Simple Syntax
Complex Syntax
Cooke et al., 2001
Concordant/
Convergent
Discordant/
Divergent
Bryan & Hale, 2001
Comprehensive Assessment Model
HOME
SCHOOL
Family Constellation
Instruction
Siblings
Attachment
Parental Mental Health
Parental Educational
Background
Resources
Interventions
Language History
Language Development
Background Knowledge
Structure
Supports
Services
Motivation
STUDENT
Developmental Status
Physical Health
Economic Resources
Social Resources
Role Models
Violence
COMMUNITY
Cognitive Abilities
Emotion Regulation
Psychopathology
Friendship
Role Models
Bullying
PEERS
The Cattell-Horn-Carroll (CHC) Model
Achievement
Basic Reading
Reading
Comprehension
Written Expression
CHC Factors
Ga-PC Phonetic Coding
(Phonemic Awareness)
Ga Auditory Processing
-Phonetic Coding
Ga-PC Phonetic Coding
Gsm Short-Term
Memory
-Memory Span
-Working Memory
Gsm Short-Term
Memory
-Memory Span
-Working Memory
Glr Long-Term Storage
and Retrieval
Glr Long-Term Storage
and Retrieval
-Naming Facility (RAN)
-Meaningful Memory
Gs Processing Speed
-Perceptual Speed
Gs Processing Speed
-Perceptual Speed
Gs Processing Speed
Gc Crystallized Ability
-Vocabulary
-Listening Skills
-Language Development
-General Knowledge
Gc Crystallized Ability
-General Knowledge
-Listening Skills
Gc Crystallized Ability
-Vocabulary
-Language Development
-General Knowledge
Gf Fluid Reasoning
CHC Model, cont.
Achievement
Basic Math
Math Reasoning
CHC Factors
Ga-PC Phonetic Coding
Ga-PC Phonetic Coding
Gsm-MW Working
Memory
Gsm Short-Term
Memory
-Memory Span
-Working Memory
Gs Processing Speed
-Perceptual Speed
Gs Processing Speed
-Perceptual Speed
Gc Crystallized Ability
Gc Crystallized Ability
Gf Fluid Reasoning
Gf Fluid Reasoning
Gq Math Knowledge
Gq Math Reasoning
Gv Visual Processing?
(Higher Math?)
Oral
Language/Listening
Comprehension
Gc Crystallized Ability
The Neuropsychology of
Reading Disorders
Word Recognition
• Phonological
Awareness
• Symbolic
Representation
• Phoneme-Grapheme
Correspondence
• Timing/Automaticity
• Word Attack vs. Sight
Word Strategies
Reading Comprehension
•
•
•
•
Semantics
Syntax
Pragmatics
Timing/AutomaticityFluency
• Explicit-Factual vs.
Implicit-Inferential
Comprehension
Double-Deficit or multiple subtypes?
Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s Handbook.
New York, NY: Guilford.
The Neuropsychology of
Math Disorders
Computation
• Quantitative
Knowledge
• Value-Grapheme
Correspondence
• Sequential/Working
Memory
• Visual-PerceptualSpatial (higher only)
• Graphomotor
Word Problems
•
•
•
•
Auditory Processing
Verbal Comprehension
Quantitative Knowledge
Word/Symbolic
Representation
• Sequential/Working
Memory
• Fluid/Quantitative
Reasoning
Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s Handbook.
New York, NY: Guilford.
Developing and Testing Hypotheses
About Cognitive Processes and Achievement
• Examine profile for significant subtest or factor scatter
• If global scores are invalid, interpret subtest performance
within and between subtests
• Use Demands Analysis to examine Input, Processing, and
Output Demands
(Caution: Processing Demands More Relevant)
• Demands Analysis is prone to error, must validate with
additional measures
(Caution: Avoid Cookbook Interpretation)
• Data must show convergent, divergent, AND ecological
validity
Demands Analysis: Block Design
Determining InputProcessingOutput Demands
Demands Analysis: WISC-IV Block Design
Determining InputProcessingOutput Demands
Input Demands:
•
•
•
•
•
Models and abstract visual pictures
Lengthy oral directions-receptive language
Demonstration and modeling
Perception of timed task
Low cultural knowledge and emotional content
Demands Analysis: WISC-IV Block Design
Determining InputProcessingOutput Demands
Processing Demands:
• Novel task for most children (note beginning vs.
later task performance-also when lines removed)
• Visual processing: Spatial-global
• Visual processing: Directional orientation-local
• Perceptual analysis (divergent thought) and synthesis
(convergent thought)
• Planning, strategizing, and monitoring performance:
Match to sample
• Sustain attention, inhibit impulsive/error
responding
Demands Analysis: WISC-IV Block Design
Determining InputProcessingOutput Demands
Output Demands:
• Fine motor response, arrange manipulatives
• Bimanual sensory (visual-somatosensory) – motor
coordination
• Processing speed
Processing Assessment
Using Specific Tests
DAS-II
Copying
Gv:Vz
Early Number
Concepts
Gq:A3, KM Receptive language, spatial and numerical
concepts
Matching Letter-Like
Forms
Gv:Vz
Visual perception, orientation, attention to
details
Matrices
Gf:I
Inductive reasoning, multiple choice
Naming Vocabulary
Gc:VL, LD Expressive naming
Pattern Construction
Gv:SR
Visual-spatial processing, constructional
praxis, planning, bimanual coordination
Phonological
Processing
Ga:PC
Phonological awareness, segmentation,
assembly
Picture Similarities
Gf:I
Fluid reasoning, visual perception
Rapid Naming
Glr:NA
Gs:Pc
Fluent retrieval from LTM; automaticity of
visual-auditory associations
Recall of Designs
Gv:MV
Visual and spatial memory
Recall Digits-Forward Gsm:MS
Visual-motor integration, graphomotor skills
Rote auditory memory, sequencing
DAS-II, cont.
Recall Digits—
Backward
Gsm:WM
Working memory for auditory material
Recall Objects—
Immediate
Glr:M6
Memory for verbal and pictorial stimuli
Recall Objects—
Delayed
Glr:M6
Longer-term memory, verbal and pictures
Recall Sequential
Order
Gsm:WM
Short-term memory for verbal and pictorial stimuli,
sequencing
Recog. of Pictures Gv:MV
Nonverbal visual memory, recognition
Seq. & Quant.
Reasoning
Gf:I, RQ
Fluid reasoning, sequential reasoning, figural and
numeric
Verbal Similarities
Gc:LD
Verbal knowledge, verbal reasoning
Speed of Info
Processing
Gs:N, R9
Processing speed, graphomotor
Verbal Comp.
Gc:LD, LS
Receptive language, basic language concepts
Word Definitions
Gc:VL, LD Verbal knowledge, oral expression
KABC-II
Simultaneous/Gv
Triangles
Visual-spatial processing, constructional praxis,
planning, bimanual coordination
Face Recognition
Visual facial memory (ventral stream)
Pattern Reasoning (5-6)
Inductive reasoning, visual processing, figural
Block Counting
Visual-spatial processing, quantitative knowledge
Story Completion (5-6)
Reasoning, sequencing, attention to visual details
Conceptual Thinking
Inductive reasoning, visual processing, pictorial
Rover
Planning, inhibition, spatial processing
Gestalt Closure
Visual processing, holistic perception
Sequential/Gsm
Word Order
Short-term auditory memory for unrelated words,
nonverbal response, later items interference task
Number Recall
Short-term auditory memory
Hand Movements
Short-term visual memory, sequencing, praxis
KABC-II, cont.
Planning/Gf
Pattern Reasoning (7-18) Inductive reasoning, visual processing, figural
Story Completion (7-18) Reasoning, sequencing, attention to visual details
Learning/Glr
Atlantis +Delayed
Associative memory, meaningless symbols and
names, syllable length cues
Rebus +Delayed
Associative memory, rebus clues to meaningful
sentences
Knowledge/Gc
Riddles
Receptive language, reasoning, long-term
memory retrieval
Expressive Vocabulary
Word knowledge, oral expression
Verbal Knowledge
General knowledge, multiple choice, pictorial
representations
CAS
Planning
Planned Codes
Gs:R9
Sustained attention, psychomotor speed, strategy use
Matching
Numbers
Gs:P
Sustained attention, visual scanning, psychomotor
speed, strategy use
Planned
Connections
Gs:P
Sustained attention, visual scanning, psychomotor
speed, strategy use
NV Matrices
Gf:I
Inductive reasoning, multiple choice
Verbal/Spatial
Relations
Gv:SR
Gc:LS
Receptive language, working memory, grammatical
relationships, visual scanning/discrimination
Simultaneous
Figural Memory Gv:MV,
CF
Visual perception, spatial relationships, visual memory,
graphomotor reproduction, constructional skills,
figure-ground relationships
CAS, cont.
Attention
Expressive
Attention
Glr:NA
Inhibition of automatic response; similar to Stroop
Number
Detection
Gs:P
Cancellation task, sustained attention, visual
scanning, visual discrimination, inhibition,
psychomotor speed
Receptive
Attention
Gs:P
Sustained attention, visual scanning, attend to
perceptual, then shift set to meaning
Word Series
Gsm:MS
Word span, rote auditory memory
Sentence
Repetition
Gsm:MS
Gc:MY
Rote recall of meaningless sentences, grammatical
structure important
Sentence
Questions
Gsm:WM
Gc:LD
Language comprehension based on grammatical
structure with meaningless content
Speech Rate
Gps:PT
Oral praxis
Successive
WISC-IV Integrated
Verbal Comprehension
Verbal Subtests Multiple Choice
Long-term memory retrieval; compares
free-recall and recognition memory
Working Memory
Visual Digit Span (Forward)
Compare visual to auditory memory span
Spatial Span (Forward and
Backward)
Compare visual to auditory working
memory
Letter Span (Forward)
Compare numbers to letters (familiarity)
L-N Seq Process Approach
Arithmetic Process Approach
Compare working memory effects
Written Arithmetic
Compare arithmetic knowledge
WISC-IV Integrated, cont.
Perceptual Reasoning
Block Design Multiple
Choice
Visual discrimination and spatial perception;
removes v-m integration and speed demands
Block Design Process
Approach
Comparison of orientation (LH) versus
configuration (RH) errors
Elithorn Mazes
Executive funtions—planning, organization,
monitoring, inhibition; graphomotor skills
Processing Speed
Coding Copy
Visual-motor integration, graphomotor skills,
processing speed
Coding Recall
Paired-associate symbol and digit recall, free
recall
CMS
Auditory/Verbal
Stories
Glr:MM
Auditory attention, semantic long-term memory
encoding and retrieval, sequencing/grammar, verbal
comprehension, expressive language
Word Pairs
Glr:MA
Paired-associate task; auditory attention, learning
novel word pairs
Word Lists
Glr:M6
Selective reminding task; long-term memory
encoding, storage and retrieval of unrelated words
Visual/Nonverbal
Dot Locations
Gv:MV
Visual-spatial memory encoding and retrieval (dorsal
stream); susceptibility to interference
Faces
Gv:MV
Facial memory encoding and retrieval (ventral stream)
Attention/Concentration
Sequences
Gsm:WM Rote recall followed by mental manipulation-executive function (working memory)
NEPSY-II
Executive Functions/Attention
Animal Sorting
Gf:I
Problem-solving, verbal and spatial concept
formation, categorical thinking, flexibility of
thinking
Auditory Atten &
Response Set
Gs
Sustained auditory atten., vigilance, inhibition, set
maintenance, flexibility
Clocks
Gv:Vz
Gc:K0
Telling time, reading analogue clocks, visual-spatial
processing, graphomotor
Design Fluency
Glr:FF
Visual-motor fluency, flexibility, divergent thinking,
graphomotor
Inhibition
Glr:NA
Naming fluency, inhibition, shifting set
Knock and Tap
Gsm:WM Self-regulation, inhibition, maintaining set
Statue
Resistance to distraction, inhibition, motor
persistance
NEPSY-II, cont.
Language
Body Part Naming Gc:K0
Knowledge of body parts, receptive and expressive
Comprehension
of Instructions
Gc:LS
Receptive language, sequencing, grammar
Oromotor
Sequences
Gps:PT
Oral praxis, sequencing, memory span
Phonological
Processing
Ga:PC
Auditory attention, phonological awareness,
segmentation, assembly
Recognition of
Reversals
Gv:MV
Gc
Visual perception of orientation, orthographic
knowledge
Repetition of
Nonsense Words
Ga:UM
Gsm:MS
Phonemic awareness, auditory memory span,
sequencing
Speeded Naming
Glr:NA
Naming automaticity, processing speed
Word Generation
Glr:FW
Verbal fluency, integrated RH/LH functioning,
compare category with letter responses
NEPSY-II, cont.
Sensorimotor Functioning
Fingertip Tapping
Gps:MT Simple motor speed, perseverance
Imitating Hand
Positions
Gp:P2
Visual perception, praxis, kinesthesis
Manual Motor Series Gp
Imitate a series of rhythmic movements
Visuomotor
Precision
Gp
Visual-motor integration, graphomotor w/o
construction
Affect Recognition
Gkn:BC
Facial processing (ventral stream), matching
emotions
Theory of Mind
Gkn:BC
Perspective taking for knowledge and emotions
Social Perception
NEPSY-II, cont.
Visuospatial Processing
Arrows
Gv:SR
Spatial processing, visualization, line orientation,
inhibition, no motor
Block
Construction
Gv:Vz
Visual-spatial processing, constructional praxis,
planning, bimanual coordination
Design
Copying
Gv:Vz
Visual-motor integration, graphomotor skills, local
and global processing
Geometric
Puzzles
Gv:Vz
Visual-spatial processing; figural, mental rotation, no
motor demands
Picture
Puzzles
Gv:CF Visual-spatial processing, pictorial, visual
Gc:K0 discrimination, local detail processing, figure-ground
Route Finding Gv:SS
Visual-spatial processing, orientation
NEPSY-II, cont.
Memory and Learning
List Learning (Delay)
Glr:M6
Verbal memory
Memory for Designs
(Delay)
Gv:MV
Visual memory, spatial recall and visual details
Memory for Faces
(Delay)
Glr:MA
Facial memory (ventral stream)
Memory for Names
(Delay)
Glr:MA
Associative memory, names and faces
Narrative Memory
Glr:MM
Meaningful memory
Sentence Repetition
Gsm:MS
Gc:LD
Auditory short-term memory, content and
grammatical structure important
Word List
Interference
Gsm:WM Auditory memory, short term and working
memory (with interference)
D-KEFS
Sorting
Problem-solving, verbal and spatial concept formation,
categorical thinking, flexibility of thinking
Trail Making
Mental flexibility, sequential processing on visual-motor
task, set shifting
Verbal Fluency
Verbal fluency
Design Fluency Visual fluency
Color-Word
Interference
Attention and response inhibition
Tower
Planning, flexibility, organization, spatial reasoning,
inhibition
20 Questions
Hypothesis testing, verbal and spatial abstract thinking,
inhibition
Word Context
Deductive reasoning, verbal abstract thinking
Proverb
Metaphorical thinking, generating versus comprehending
abstract thoughts
CTOPP
Phonological Awareness
Elision
Ga:PC
Phonological perception, segmentation
Blending Words
Ga:PC
Phonological assembly
Sound Matching
Ga:PC
Phonological perception, segmentation
Phoneme Reversal
Ga:PC
Phonological perception, segmentation,
Gsm:WM working memory
Blending Nonwords Ga:PC
Phonological assembly
Segmenting
Nonwords
Phonological perception, segmentation
Ga:PC
Phonological Memory
Memory for Digits
Gsm:MS
Short-term memory, sequencing
Nonword
Repetition
Ga:UM
Gsm:MS
Phonemic analysis, assembly, working memory
CTOPP, cont.
Rapid Naming
Rapid Digit
Naming
Glr: NA Number automaticity, processing speed, verbal
fluency
Rapid Letter
Naming
Glr: NA Letter automaticity, processing speed, verbal
fluency
Rapid Color
Naming
Glr: NA Color name knowledge, naming automaticity,
processing speed, verbal fluency
Rapid Object
Naming
Glr: NA Object recognition, naming automaticity,
processing speed, verbal fluency
Tests Discussed
•
•
•
•
•
•
•
•
CMS Children’s Memory Scale PsychCorp/Pearson
CAS Cognitive Assessment System Riverside
CTOPP Comprehensive Test of Phonological Processing Pro-Ed
DAS-II Differential Abilities Scales Second Edition
PsychCorp/Pearson
D-KEFS Delis-Kaplan Executive Function System
PsychCorp/Pearson
KABC-II Kaufman Assessment Battery for Children Second Edition
Pearson Assessments
NEPSY-II PsychCorp/Pearson
WISC-IV Integrated PsychCorp/Pearson

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